title: A multidisciplinary support programme increases the efficiency of pegylated interferon alfa-2a and ribavirin in hepatitis C.
abstract: OBJECTIVE
  Adherence to antiviral treatment is important to achieve sustained virological response (SVR) in chronic hepatitis C (CHC). We evaluated the efficiency of a multidisciplinary support programme (MSP), based on published HIV treatment experience, to increase patient adherence and the efficacy of pegylated interferon alfa-2a and ribavirin in CHC.
  
  
  METHODS
  447 patients receiving antiviral treatment were distributed into 3 groups: control group (2003-2004, n=147), MSP group (2005-2006, n=131), and MSP-validation group (2007-2009, n=169). The MSP group included two hepatologists, two nurses, one pharmacist, one psychologist, one administrative assistant, and one psychiatrist. Cost-effectiveness analysis was performed using a Markov model.
  
  
  RESULTS
  Adherence and SVR rates were higher in the MSP (94.6% and 77.1%) and MSP-validation (91.7% and 74.6%) groups compared to controls (78.9% and 61.9%) (p<0.05 in all cases). SVR was higher in genotypes 1 or 4 followed by the MSP group vs. controls (67.7% vs. 48.9%, p=0.02) compared with genotypes 2 or 3 (87.7% vs. 81.4%, p=n.s.). The MSP was the main predictive factor of SVR in patients with genotype 1. The rate of adherence in patients with psychiatric disorders was higher in the MSP groups (n=95, 90.5%) compared to controls (n=28, 75.7%) (p=0.02). The cost per patient was € 13,319 in the MSP group and € 16,184 in the control group. The MSP group achieved more quality-adjusted life years (QALYs) (16.317 QALYs) than controls (15.814 QALYs) and was dominant in all genotypes.
  
  
  CONCLUSIONS
  MSP improves patient compliance and increases the efficiency of antiviral treatment in CHC, being cost-effective.
authors.affiliation: Liver Section, Gastroenterology Department, Hospital del Mar, Universitat Autònoma de Barcelona, IMIM (Institut Hospital del Mar d'Investigacions Mèdiques), Barcelona, Spain. Electronic address: 95565@parcdesalutmar.cat.
authors.forename: José Antonio
authors.initials: JA
authors.lastname: Carrión
authors.forename: Elena
authors.initials: E
authors.lastname: Gonzalez-Colominas
authors.forename: Montserrat
authors.initials: M
authors.lastname: García-Retortillo
authors.forename: Nuria
authors.initials: N
authors.lastname: Cañete
authors.forename: Isabel
authors.initials: I
authors.lastname: Cirera
authors.forename: Susanna
authors.initials: S
authors.lastname: Coll
authors.forename: Maria Dolors
authors.initials: MD
authors.lastname: Giménez
authors.forename: Carmen
authors.initials: C
authors.lastname: Márquez
authors.forename: Victoria
authors.initials: V
authors.lastname: Martin-Escudero
authors.forename: Pere
authors.initials: P
authors.lastname: Castellví
authors.forename: Ricard
authors.initials: R
authors.lastname: Navinés
authors.forename: Juan Ramon
authors.initials: JR
authors.lastname: Castaño
authors.forename: Josep Anton
authors.initials: JA
authors.lastname: Galeras
authors.forename: Esther
authors.initials: E
authors.lastname: Salas
authors.forename: Felipe
authors.initials: F
authors.lastname: Bory
authors.forename: Rocío
authors.initials: R
authors.lastname: Martín-Santos
authors.forename: Ricard
authors.initials: R
authors.lastname: Solà
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D004359:Drug Therapy, Combination; D005260:Female; D005838:Genotype; D016174:Hepacivirus / Q000235:genetics; D006526:Hepatitis C / Q000188:drug therapy*; D006801:Humans; D033183:Interdisciplinary Communication; D016898:Interferon-alpha / Q000191:economics / Q000627:therapeutic use*; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology*; D011092:Polyethylene Glycols / Q000191:economics / Q000627:therapeutic use*; D019057:Quality-Adjusted Life Years; D011994:Recombinant Proteins / Q000191:economics / Q000627:therapeutic use; D012254:Ribavirin / Q000191:economics / Q000627:therapeutic use*; D012657:Self-Help Groups; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C100416:peginterferon alfa-2a
keywords: 95% CI; 95% confidence interval; ALT; ANC; BOC; CHC; Cost-effectiveness; DAA; EOT; EPO; G-CSF; HADS; HBV; HCC; HCV; HIV; Hb; Hepatitis; ICER; MSP; NR; OR; PCR; PHQ; PLT; Programme; QALY; RBV; Response; SE; SVR; TVR; Treatment; ULN; absolute neutrophil count; alanine aminotransferase; boceprevir; chronic hepatitis C; direct-acting antivirals; end of treatment; erythropoietin; granulocyte colony-stimulating factor; haemoglobin; hepatitis B virus; hepatitis C virus; hepatocellular carcinoma; hospital anxiety and depression scale; human immunodeficiency virus; incremental cost-effectiveness ratio; multidisciplinary support programme; non-responders; odds ratio; patient health questionnaires; pegIFN; pegylated interferon; polymerase chain reaction; potentially life threatening; quality-adjusted life year; ribavirin; standard error; sustained virological response; telaprevir; upper limit of normal